Rise Of Violence Against Medical Fraternity
The author of this blog is Rania Naushad currently in third Semester BBA LLB(HONS), Government Law College, Thrissur.
“It's the best time ever to be a doctor because you can heal and treat conditions that were untreatable even a few years ago.”-Quoted by Joseph Murray.
The ferocious activities that has taken place against the medical faculties should be referred to as a mere indication of inhumanity. But such poignant incidents hardly came across Indian debates, journals or even discussions till the menace of COVID- 19 came up in our country. In the majority of the cases (60-70%), such violence took the form of either verbal abuse or aggressive gesture.[1]The prevalence of such violent crimes has augmented from 2006-2017, with the highest violent rate occurring in Delhi, Maharashtra, and Uttar Pradesh.[2]
Some reported cases of Violence and study revealing the cause of Violence
On 14 June 2018 , Goons tied a doctor to a tree, gang raped his wife, and robbed his money and belongings in the Gaya district of Bihar.[3]On 21 May 2019,Drunk attendants assault NIMS hospital.[4]The IMA Survey reveals that majority of doctors in India fear violence.[5] Recently in China one dentist was killed by his patient 20 year after he treated his patients and the patient was injured.[6]According to the American College of Emergency Physicians (ACEP), nearly 7 out of 10 emergency physicians believe that emergency department violence is increasing. Also, 47% of physicians have said that they’d personally been physically assaulted at work.[7] In 2011 the Emergency Nurse Association studies the prevalence of physical violence at 54.4% and verbal violence at 42.5% among emergency room nurses. Within this study, 55.7% perpetrators of physical violence were under the influence of alcohol, 46.8% were under the influence of illegal or prescription drugs, and 45.2% were being treated for psychiatric reasons. A survey by the Chinese Hospital Association delineated an average of 27.3 assaults per hospital per year in 2012, up from 20.6 assaults per hospital per year in 2006. Because of the rising level of concern about violence towards health workers, a joint international program was initiated involving the International Labour Office (ILO), the International Council of Nurses, the World Health Organisation , and Public Services International.[8] The following data reveals Prevalence of violence by visitor according to different shifts and reason of violence against the medical fraternity. Two hundred two (80.8%) health care staff experienced verbal violence by visitor in the morning shift, 192 (76.8%) in the evening shift, 114 (45.6%) in the night shift, followed by psychological violence 192 (76.8%), 184 (73.6%) and 102 (40.8%) respectively. Nurses and doctors identified nine (9) perceived causes of violence by visitors. The most frequent causes of violent acts by the visitor were: violation of visiting hours (88.8%), long waiting periods (86.4%), psychological problems like anger and anxiety (83.2%) and smoking prohibition (82.4%) [9]
Violence against health care personnel during COVID-19 and synopsis of the Ordinance promulgated by the President of India
The violence against healthcare personnel is amplifying even during the COVID -19 times. It is due to all these incidents that urged the Indian Medical Association (IMA) to declare White Alert to the nation on 22 April 2020 and Black Day on 23 April 2020.The President has promulgated an The Epidemic Diseases (Amendment) Ordinance, 2020 making violence against healthcare facilities who are tirelessly fighting COVID -19 pandemic as cognizable and non-bailable offences. The ordinance amends the Epidemic Diseases Act, 1897 provides for compensation for injury to medical fraternity or for causing damage or loss to property. The abetment or commission of such atrocious violence is punishable with imprisonment for a term of three months to five years and with fine of Rs 50000 to Rs 2,00,000.In case of grevious hurt imprisonment shall be for a term six months to seven years and with a fine of Rs 1,00,000 to Rs 5,00,000. The wrongdoer will also be liable to pay compensation to the victim and twice the fair market value for damage of property.
The healthcare service personnel include public and clinical healthcare service providers such as doctors, nurses, paramedical workers and community health workers; and all other persons authorized under the act to take measures to avert the spread of the disease; and any persons declared as such by the State Government, by notification in the official gazette. Violence here encompasses physical injury, harassment and damage to property. Offences will be investigated by an officer of the rank of inspector within a period of 30 days, and the trial has to be completed in one year unless extended by the court for reasons to be recorded in writing.[10]
How do we tackle such situations during the normal course of time?
But the nub of the issue is what after the pandemic? Will the ordinance prevail to ensure the safety of healthcare service personnel? It is an epidemic that very few has vocalized.
Radiologists and other physicians are giving a full court press for greater protection against their peers during COVID-19 pandemic. To remedy these concerns, they’re asking lawmakers to consider enacting the “COVID-19 Pandemic Physician Protection Act,” and have gathered more than 90,000 signatures to back their request.[11]
In India at least 19 states have passed the Protection Of Medicare Service Persons And Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, also known as the Medical Protection Act (MPA) that bulwarks the doctors but their implementation is not sturdy. The Act, covering doctors affiliated to institutions as well as independent practitioners, outlaws attacks against physicians and damage to their property. The Act, however, fails to fortify doctors because it features neither in the Indian Penal Code (IPC) nor in the Code of Criminal Procedure (CrPC). This makes it onerous for victims to approach the police for help or the latter to file a complaint against suspects. Implementation of a central law is not possible since the area of health including safeguarding of doctors is a “state subject.”[12]
According to the Doctor’s Protection Act in India:
· Any damage or act of violence against Medicare professionals is an act punishable by law. Medicare professionals include (Doctors, nurses, paramedics, medical students, hospital attendants/staff)
· Any damage to the property or the Institution of Medicare service is prohibited. Destruction of hospital beds, burning of ambulances, smashing medical stores is punishable by law
· Imprisonment to lawbreakers for a minimum period of 3 years and fine amount of INR 50,000 to be imposed if found guilty.
· Offenders of medical professionals/medical colleges can be cognizable or non- cognizable crime depending upon the offences committed.
· Damage to any medical devices and equipments is a punishable offence and the offenders are liable to pay twice the amount of the damaged equipment’s cost.
A Judge bench formed in 2005, August Justice R.C Lahoti, Justice G.P Mathur and Justice P.K Subramanian said Medical negligence act amounting to culpable homicide shall be punished with IPC 304-A imprisonment extending up to many years depending on the medical negligence.
The law mentions that prima-facie evidence before the court is to be submitted and verified by a government doctor of the same rank. This law also protects the physicians from false allegations and fake medical complications complaints to extort money from the alleged doctors. The IPC 304-A cognizable offence also can result into police arresting the doctor without any warrant. However there is an impending appeal in High court that doctors not to be trialed as criminals. As they spend their entire life serving the mankind. Doctors excerpts “We are not god”, human body is not immortal, we treat our patients to best of our knowledge but due to unforeseen circumstances we can also make mistakes termed as medical negligence.[13]
Comprehending the current scenario of violence against health care personnel
Such cases of domestic violence are splurging bane. The verity is that it is entrenched to across the globe. To mitigate such violence doctors must comprehend what are the possible patient related attributes that induces them to such violence. The hospital management must ensure satisfactory services, adequate number of staffs to treat the patients without making them anxious, worthy technology system, satisfactory complaint redressal system. The health systems need to have panic buttons, limited guest hours, metal detectors, police presence, security cameras, de-escalation training, emergency preparedness and more.[14] The patients and their families must realize that modern medicines and treatment cannot always have a perfect outcome and realize the consequences of indulging into such inhuman acts. There are several such incidents of brutality against doctors which has taken place across the country whether reported or unreported but unnoticed by most of us. The initiative to increase public health spending to 2.5% of GDP should be considered as a start to the right direction. All of us together must unfold, uncoil, unravel every bits possible to protect the ones who risk their lives to protect millions of other lives, the unknown, unsung, untold, unrevealed heroes of our lives.
[1] Kanjaksha Ghosh ,Violence against doctors: A wake-up call, 2018 Aug; 148(2): 130–133 (The Indian Journal of Medical Research)
[2] Ranjan, Rajesh; Meenakshi; Singh, Mitasha; Pal, Ranabir; Das, JayantaK; Gupta, Sanjay (2018). "Epidemiology of violence against medical practitioners in a developing country (2006-2017)". Journal of Health Research and Reviews
[3] Anand ST Das , Bihar goons tie doctor to a tree, gang rape his wife, teenage daughter; 20 suspects detained
The New Indian Express, 14th June 2018 08:43 PM
[4]Drunk attendants assault NIMS hospital, The Hindu, May 21 2019 00:54 IST.
[5] Bindu Shajan Perappadan, Majority of doctors in India fear violence, The Hindu, July 02 2017 22:08 IST.
[6] Kanjaksha Ghosh ,Violence against doctors: A wake-up call, 2018 Aug; 148(2): 130–133 (The Indian Journal of Medical Research)
[7] Wallace Stephens, https://www.ajmc.com/focus-of-the-week/violence-against-healthcare-workers-a-rising-epidemic, Published on: May 12, 2019
[8] Vol 19(6), Claire Mayhew and Duncan Chappell in cooperation with ILO,ICN,WHO,PSI Joint Programme on Workplace Violence in the Health Sector, Originally Published in The Journal of Occupational Health and Safety –Australia and New Zealand ,2003.
https://www.who.int/violence_injury_prevention/violence/en/wpv_australia.pdf.
[9] Evmorfia Koukia*, Polyxeni Mangoulia, Nikolaos Gonis, Theofanis Katostaras, Violence against health care staff by patient’s visitor in general hospital in Greece: Possible causes and economic crisis, Open Journal of Nursing
Vol.3 No.8A(2013), Article ID:41033,7 pages DOI:10.4236/ojn.2013.38A004
[10] Doctors welcome Ordinance to check against health workers, ANI , April 23 2020.
[11] Marty Stampniak ,’Radiologists, other docs push policymakers to adopt ‘COVID-19 Pandemic Physician Protection Act’, April 06 2020,https://www.radiologybusiness.com/topics/policy/radiologist-covid-19-pandemic-physician-protection-act.
[12]Simrin Sirur, There is a law to protect doctors from assault but this is why it doesn’t work,14 June, 2019 8:18 pm IST, https://theprint.in/india/there-is-a-law-to-protect-doctors-from-assault-but-this-is-why-it-doesnt-work.
[13] http://www.hiimpact.in/blog/health/are-you-aware-of-your-protection-laws-doctors.
[14] Lydia Coutré , https://www.modernhealthcare.com/providers/healthcare-workers-face-violence-epidemic, March 11, 2019 12:19 PM.
Violence against health care personnel during COVID-19 and synopsis of the Ordinance promulgated by the President of India
The violence against healthcare personnel is amplifying even during the COVID -19 times. It is due to all these incidents that urged the Indian Medical Association (IMA) to declare White Alert to the nation on 22 April 2020 and Black Day on 23 April 2020.The President has promulgated an The Epidemic Diseases (Amendment) Ordinance, 2020 making violence against healthcare facilities who are tirelessly fighting COVID -19 pandemic as cognizable and non-bailable offences. The ordinance amends the Epidemic Diseases Act, 1897 provides for compensation for injury to medical fraternity or for causing damage or loss to property. The abetment or commission of such atrocious violence is punishable with imprisonment for a term of three months to five years and with fine of Rs 50000 to Rs 2,00,000.In case of grevious hurt imprisonment shall be for a term six months to seven years and with a fine of Rs 1,00,000 to Rs 5,00,000. The wrongdoer will also be liable to pay compensation to the victim and twice the fair market value for damage of property.
The healthcare service personnel include public and clinical healthcare service providers such as doctors, nurses, paramedical workers and community health workers; and all other persons authorized under the act to take measures to avert the spread of the disease; and any persons declared as such by the State Government, by notification in the official gazette. Violence here encompasses physical injury, harassment and damage to property. Offences will be investigated by an officer of the rank of inspector within a period of 30 days, and the trial has to be completed in one year unless extended by the court for reasons to be recorded in writing.[10]
How do we tackle such situations during the normal course of time?
But the nub of the issue is what after the pandemic? Will the ordinance prevail to ensure the safety of healthcare service personnel? It is an epidemic that very few has vocalized.
Radiologists and other physicians are giving a full court press for greater protection against their peers during COVID-19 pandemic. To remedy these concerns, they’re asking lawmakers to consider enacting the “COVID-19 Pandemic Physician Protection Act,” and have gathered more than 90,000 signatures to back their request.[11]
In India at least 19 states have passed the Protection Of Medicare Service Persons And Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, also known as the Medical Protection Act (MPA) that bulwarks the doctors but their implementation is not sturdy. The Act, covering doctors affiliated to institutions as well as independent practitioners, outlaws attacks against physicians and damage to their property. The Act, however, fails to fortify doctors because it features neither in the Indian Penal Code (IPC) nor in the Code of Criminal Procedure (CrPC). This makes it onerous for victims to approach the police for help or the latter to file a complaint against suspects. Implementation of a central law is not possible since the area of health including safeguarding of doctors is a “state subject.”[12]
According to the Doctor’s Protection Act in India:
· Any damage or act of violence against Medicare professionals is an act punishable by law. Medicare professionals include (Doctors, nurses, paramedics, medical students, hospital attendants/staff)
· Any damage to the property or the Institution of Medicare service is prohibited. Destruction of hospital beds, burning of ambulances, smashing medical stores is punishable by law
· Imprisonment to lawbreakers for a minimum period of 3 years and fine amount of INR 50,000 to be imposed if found guilty.
· Offenders of medical professionals/medical colleges can be cognizable or non- cognizable crime depending upon the offences committed.
· Damage to any medical devices and equipments is a punishable offence and the offenders are liable to pay twice the amount of the damaged equipment’s cost.
A Judge bench formed in 2005, August Justice R.C Lahoti, Justice G.P Mathur and Justice P.K Subramanian said Medical negligence act amounting to culpable homicide shall be punished with IPC 304-A imprisonment extending up to many years depending on the medical negligence.
The law mentions that prima-facie evidence before the court is to be submitted and verified by a government doctor of the same rank. This law also protects the physicians from false allegations and fake medical complications complaints to extort money from the alleged doctors. The IPC 304-A cognizable offence also can result into police arresting the doctor without any warrant. However there is an impending appeal in High court that doctors not to be trialed as criminals. As they spend their entire life serving the mankind. Doctors excerpts “We are not god”, human body is not immortal, we treat our patients to best of our knowledge but due to unforeseen circumstances we can also make mistakes termed as medical negligence.[13]
Comprehending the current scenario of violence against health care personnel
Such cases of domestic violence are splurging bane. The verity is that it is entrenched to across the globe. To mitigate such violence doctors must comprehend what are the possible patient related attributes that induces them to such violence. The hospital management must ensure satisfactory services, adequate number of staffs to treat the patients without making them anxious, worthy technology system, satisfactory complaint redressal system. The health systems need to have panic buttons, limited guest hours, metal detectors, police presence, security cameras, de-escalation training, emergency preparedness and more.[14] The patients and their families must realize that modern medicines and treatment cannot always have a perfect outcome and realize the consequences of indulging into such inhuman acts. There are several such incidents of brutality against doctors which has taken place across the country whether reported or unreported but unnoticed by most of us. The initiative to increase public health spending to 2.5% of GDP should be considered as a start to the right direction. All of us together must unfold, uncoil, unravel every bits possible to protect the ones who risk their lives to protect millions of other lives, the unknown, unsung, untold, unrevealed heroes of our lives.
[1] Kanjaksha Ghosh ,Violence against doctors: A wake-up call, 2018 Aug; 148(2): 130–133 (The Indian Journal of Medical Research)
[2] Ranjan, Rajesh; Meenakshi; Singh, Mitasha; Pal, Ranabir; Das, JayantaK; Gupta, Sanjay (2018). "Epidemiology of violence against medical practitioners in a developing country (2006-2017)". Journal of Health Research and Reviews
[3] Anand ST Das , Bihar goons tie doctor to a tree, gang rape his wife, teenage daughter; 20 suspects detained
The New Indian Express, 14th June 2018 08:43 PM
[4]Drunk attendants assault NIMS hospital, The Hindu, May 21 2019 00:54 IST.
[5] Bindu Shajan Perappadan, Majority of doctors in India fear violence, The Hindu, July 02 2017 22:08 IST.
[6] Kanjaksha Ghosh ,Violence against doctors: A wake-up call, 2018 Aug; 148(2): 130–133 (The Indian Journal of Medical Research)
[7] Wallace Stephens, https://www.ajmc.com/focus-of-the-week/violence-against-healthcare-workers-a-rising-epidemic, Published on: May 12, 2019
[8] Vol 19(6), Claire Mayhew and Duncan Chappell in cooperation with ILO,ICN,WHO,PSI Joint Programme on Workplace Violence in the Health Sector, Originally Published in The Journal of Occupational Health and Safety –Australia and New Zealand ,2003.
https://www.who.int/violence_injury_prevention/violence/en/wpv_australia.pdf.
[9] Evmorfia Koukia*, Polyxeni Mangoulia, Nikolaos Gonis, Theofanis Katostaras, Violence against health care staff by patient’s visitor in general hospital in Greece: Possible causes and economic crisis, Open Journal of Nursing
Vol.3 No.8A(2013), Article ID:41033,7 pages DOI:10.4236/ojn.2013.38A004
[10] Doctors welcome Ordinance to check against health workers, ANI , April 23 2020.
[11] Marty Stampniak ,’Radiologists, other docs push policymakers to adopt ‘COVID-19 Pandemic Physician Protection Act’, April 06 2020,https://www.radiologybusiness.com/topics/policy/radiologist-covid-19-pandemic-physician-protection-act.
[12]Simrin Sirur, There is a law to protect doctors from assault but this is why it doesn’t work,14 June, 2019 8:18 pm IST, https://theprint.in/india/there-is-a-law-to-protect-doctors-from-assault-but-this-is-why-it-doesnt-work.
[13] http://www.hiimpact.in/blog/health/are-you-aware-of-your-protection-laws-doctors.
[14] Lydia Coutré , https://www.modernhealthcare.com/providers/healthcare-workers-face-violence-epidemic, March 11, 2019 12:19 PM.
It's nice to see something like this ❤️ Rania , you did a wonderful job and I hope you keep on doing what you are doing and hope that you have a successful career in your future ❤️
ReplyDeleteI haven't read anything like this in my life and your work is flawless ❤️ can't find any flaws in it and whatever is written is just perfect. You will be a great lawyer and hope you get a great job outside India like you always wanted ❤️
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